|
Celiac Serology EMA
|
Facility
|
OP
|
$427.00
|
|
|
Service Code
|
CPT 88346
|
| Hospital Charge Code |
3331526
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$179.30 |
| Max. Negotiated Rate |
$717.18 |
| Rate for Payer: Aetna Commercial |
$399.67
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$381.91
|
| Rate for Payer: Aetna Managed Medicare |
$179.30
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$658.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$307.25
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$291.45
|
| Rate for Payer: Anthem Medicare Advantage |
$179.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$235.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$179.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$179.30
|
| Rate for Payer: Cash Price |
$128.10
|
| Rate for Payer: Cash Price |
$128.10
|
| Rate for Payer: Cigna Commercial |
$408.55
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$179.30
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$248.51
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$179.30
|
| Rate for Payer: Health EOS Commercial |
$395.23
|
| Rate for Payer: HFN Commercial |
$408.55
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$666.98
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$179.30
|
| Rate for Payer: Independent Care Health Plan Medicare |
$179.30
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$179.30
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$179.30
|
| Rate for Payer: Multiplan Commercial |
$355.26
|
| Rate for Payer: NAPHCARE Commercial |
$268.94
|
| Rate for Payer: Preferred Network Access Commercial |
$408.55
|
| Rate for Payer: Quartz Beloit One Network |
$217.60
|
| Rate for Payer: Quartz Commercial |
$288.65
|
| Rate for Payer: Quartz Medicare Advantage |
$179.30
|
| Rate for Payer: The Alliance Commercial |
$717.18
|
| Rate for Payer: United Healthcare Medicare Advantage |
$179.30
|
| Rate for Payer: United Healthcare PPO |
$333.06
|
| Rate for Payer: WEA Trust Commercial |
$244.24
|
| Rate for Payer: Wellcare Medicare |
$179.30
|
| Rate for Payer: WPS Commercial |
$328.92
|
|
|
Celiac Serology IgA
|
Facility
|
IP
|
$40.00
|
|
|
Service Code
|
CPT 82784
|
| Hospital Charge Code |
2790812
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$20.38 |
| Max. Negotiated Rate |
$38.27 |
| Rate for Payer: Aetna Commercial |
$37.44
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$35.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$22.05
|
| Rate for Payer: Cash Price |
$12.00
|
| Rate for Payer: Cigna Commercial |
$38.27
|
| Rate for Payer: Health EOS Commercial |
$37.02
|
| Rate for Payer: HFN Commercial |
$38.27
|
| Rate for Payer: Multiplan Commercial |
$33.28
|
| Rate for Payer: Preferred Network Access Commercial |
$38.27
|
| Rate for Payer: Quartz Beloit One Network |
$20.38
|
| Rate for Payer: Quartz Commercial |
$24.96
|
| Rate for Payer: WEA Trust Commercial |
$22.88
|
| Rate for Payer: WPS Commercial |
$30.81
|
|
|
Celiac Serology IgA
|
Professional
|
Both
|
$40.00
|
|
|
Service Code
|
CPT 82784
|
| Hospital Charge Code |
2790812
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.67 |
| Max. Negotiated Rate |
$42.56 |
| Rate for Payer: Aetna Commercial |
$39.52
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$35.78
|
| Rate for Payer: Aetna Managed Medicare |
$9.67
|
| Rate for Payer: Anthem Medicare Advantage |
$9.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$9.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$9.67
|
| Rate for Payer: Cash Price |
$12.00
|
| Rate for Payer: Cash Price |
$12.00
|
| Rate for Payer: Cigna Commercial |
$39.52
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$20.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$9.67
|
| Rate for Payer: Health EOS Commercial |
$37.86
|
| Rate for Payer: HFN Commercial |
$39.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$34.14
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$34.14
|
| Rate for Payer: Independent Care Health Plan Medicare |
$9.67
|
| Rate for Payer: Multiplan Commercial |
$33.28
|
| Rate for Payer: NAPHCARE Commercial |
$14.51
|
| Rate for Payer: Preferred Network Access Commercial |
$39.52
|
| Rate for Payer: Quartz Beloit One Network |
$18.30
|
| Rate for Payer: Quartz Commercial |
$23.71
|
| Rate for Payer: Quartz Medicare Advantage |
$9.67
|
| Rate for Payer: The Alliance Commercial |
$38.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$9.67
|
| Rate for Payer: WEA Trust Commercial |
$22.88
|
| Rate for Payer: WPS Commercial |
$42.56
|
|
|
Celiac Serology IgA
|
Facility
|
OP
|
$40.00
|
|
|
Service Code
|
CPT 82784
|
| Hospital Charge Code |
2790812
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.67 |
| Max. Negotiated Rate |
$38.69 |
| Rate for Payer: Aetna Commercial |
$37.44
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$35.78
|
| Rate for Payer: Aetna Managed Medicare |
$9.67
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$36.27
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$16.93
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$16.06
|
| Rate for Payer: Anthem Medicare Advantage |
$9.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$22.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$9.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$9.67
|
| Rate for Payer: Cash Price |
$12.00
|
| Rate for Payer: Cash Price |
$12.00
|
| Rate for Payer: Cigna Commercial |
$38.27
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$9.67
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$23.28
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$9.67
|
| Rate for Payer: Health EOS Commercial |
$37.02
|
| Rate for Payer: HFN Commercial |
$38.27
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$35.98
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$9.67
|
| Rate for Payer: Independent Care Health Plan Medicare |
$9.67
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$9.67
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$9.67
|
| Rate for Payer: Multiplan Commercial |
$33.28
|
| Rate for Payer: NAPHCARE Commercial |
$14.51
|
| Rate for Payer: Preferred Network Access Commercial |
$38.27
|
| Rate for Payer: Quartz Beloit One Network |
$20.38
|
| Rate for Payer: Quartz Commercial |
$27.04
|
| Rate for Payer: Quartz Medicare Advantage |
$9.67
|
| Rate for Payer: The Alliance Commercial |
$38.69
|
| Rate for Payer: United Healthcare Medicare Advantage |
$9.67
|
| Rate for Payer: United Healthcare PPO |
$31.20
|
| Rate for Payer: WEA Trust Commercial |
$22.88
|
| Rate for Payer: Wellcare Medicare |
$9.67
|
| Rate for Payer: WPS Commercial |
$30.81
|
|
|
Celiac Serology to Prometheus
|
Professional
|
Both
|
$702.00
|
|
|
Service Code
|
CPT 81382
|
| Hospital Charge Code |
3062694
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$128.63 |
| Max. Negotiated Rate |
$693.58 |
| Rate for Payer: Aetna Commercial |
$693.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$627.87
|
| Rate for Payer: Aetna Managed Medicare |
$128.63
|
| Rate for Payer: Anthem Medicare Advantage |
$128.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$128.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$128.63
|
| Rate for Payer: Cash Price |
$210.60
|
| Rate for Payer: Cash Price |
$210.60
|
| Rate for Payer: Cigna Commercial |
$693.58
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$365.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$128.63
|
| Rate for Payer: Health EOS Commercial |
$664.37
|
| Rate for Payer: HFN Commercial |
$693.58
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$454.05
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$454.05
|
| Rate for Payer: Independent Care Health Plan Medicare |
$128.63
|
| Rate for Payer: Multiplan Commercial |
$584.06
|
| Rate for Payer: NAPHCARE Commercial |
$192.94
|
| Rate for Payer: Preferred Network Access Commercial |
$693.58
|
| Rate for Payer: Quartz Beloit One Network |
$321.24
|
| Rate for Payer: Quartz Commercial |
$416.15
|
| Rate for Payer: Quartz Medicare Advantage |
$128.63
|
| Rate for Payer: The Alliance Commercial |
$508.08
|
| Rate for Payer: United Healthcare Medicare Advantage |
$128.63
|
| Rate for Payer: WEA Trust Commercial |
$401.54
|
| Rate for Payer: WPS Commercial |
$565.96
|
|
|
Celiac Serology to Prometheus
|
Facility
|
OP
|
$702.00
|
|
|
Service Code
|
CPT 81382
|
| Hospital Charge Code |
3062694
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$128.63 |
| Max. Negotiated Rate |
$671.67 |
| Rate for Payer: Aetna Commercial |
$657.07
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$627.87
|
| Rate for Payer: Aetna Managed Medicare |
$128.63
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$482.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$225.10
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$213.52
|
| Rate for Payer: Anthem Medicare Advantage |
$128.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$386.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$128.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$128.63
|
| Rate for Payer: Cash Price |
$210.60
|
| Rate for Payer: Cash Price |
$210.60
|
| Rate for Payer: Cigna Commercial |
$671.67
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$128.63
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$408.56
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$128.63
|
| Rate for Payer: Health EOS Commercial |
$649.77
|
| Rate for Payer: HFN Commercial |
$671.67
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$478.49
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$128.63
|
| Rate for Payer: Independent Care Health Plan Medicare |
$128.63
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$128.63
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$128.63
|
| Rate for Payer: Multiplan Commercial |
$584.06
|
| Rate for Payer: NAPHCARE Commercial |
$192.94
|
| Rate for Payer: Preferred Network Access Commercial |
$671.67
|
| Rate for Payer: Quartz Beloit One Network |
$357.74
|
| Rate for Payer: Quartz Commercial |
$474.55
|
| Rate for Payer: Quartz Medicare Advantage |
$128.63
|
| Rate for Payer: The Alliance Commercial |
$514.51
|
| Rate for Payer: United Healthcare Medicare Advantage |
$128.63
|
| Rate for Payer: United Healthcare PPO |
$547.56
|
| Rate for Payer: WEA Trust Commercial |
$401.54
|
| Rate for Payer: Wellcare Medicare |
$128.63
|
| Rate for Payer: WPS Commercial |
$540.75
|
|
|
Celiac Serology to Prometheus
|
Facility
|
IP
|
$702.00
|
|
|
Service Code
|
CPT 81382
|
| Hospital Charge Code |
3062694
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$357.74 |
| Max. Negotiated Rate |
$671.67 |
| Rate for Payer: Aetna Commercial |
$657.07
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$627.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$386.94
|
| Rate for Payer: Cash Price |
$210.60
|
| Rate for Payer: Cigna Commercial |
$671.67
|
| Rate for Payer: Health EOS Commercial |
$649.77
|
| Rate for Payer: HFN Commercial |
$671.67
|
| Rate for Payer: Multiplan Commercial |
$584.06
|
| Rate for Payer: Preferred Network Access Commercial |
$671.67
|
| Rate for Payer: Quartz Beloit One Network |
$357.74
|
| Rate for Payer: Quartz Commercial |
$438.05
|
| Rate for Payer: WEA Trust Commercial |
$401.54
|
| Rate for Payer: WPS Commercial |
$540.75
|
|
|
Celiac Serology TTG
|
Professional
|
Both
|
$110.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
2790816
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.96 |
| Max. Negotiated Rate |
$108.68 |
| Rate for Payer: Aetna Commercial |
$108.68
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$98.38
|
| Rate for Payer: Aetna Managed Medicare |
$17.96
|
| Rate for Payer: Anthem Medicare Advantage |
$17.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$17.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$17.96
|
| Rate for Payer: Cash Price |
$33.00
|
| Rate for Payer: Cash Price |
$33.00
|
| Rate for Payer: Cigna Commercial |
$108.68
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$57.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$17.96
|
| Rate for Payer: Health EOS Commercial |
$104.10
|
| Rate for Payer: HFN Commercial |
$108.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$63.40
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$63.40
|
| Rate for Payer: Independent Care Health Plan Medicare |
$17.96
|
| Rate for Payer: Multiplan Commercial |
$91.52
|
| Rate for Payer: NAPHCARE Commercial |
$26.94
|
| Rate for Payer: Preferred Network Access Commercial |
$108.68
|
| Rate for Payer: Quartz Beloit One Network |
$50.34
|
| Rate for Payer: Quartz Commercial |
$65.21
|
| Rate for Payer: Quartz Medicare Advantage |
$17.96
|
| Rate for Payer: The Alliance Commercial |
$70.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.96
|
| Rate for Payer: WEA Trust Commercial |
$62.92
|
| Rate for Payer: WPS Commercial |
$79.03
|
|
|
Celiac Serology TTG
|
Facility
|
OP
|
$110.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
2790816
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.96 |
| Max. Negotiated Rate |
$105.25 |
| Rate for Payer: Aetna Commercial |
$102.96
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$98.38
|
| Rate for Payer: Aetna Managed Medicare |
$17.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$67.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$31.43
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$29.81
|
| Rate for Payer: Anthem Medicare Advantage |
$17.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$60.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$17.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$17.96
|
| Rate for Payer: Cash Price |
$33.00
|
| Rate for Payer: Cash Price |
$33.00
|
| Rate for Payer: Cigna Commercial |
$105.25
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$17.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$64.02
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$17.96
|
| Rate for Payer: Health EOS Commercial |
$101.82
|
| Rate for Payer: HFN Commercial |
$105.25
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$66.81
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$17.96
|
| Rate for Payer: Independent Care Health Plan Medicare |
$17.96
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$17.96
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$17.96
|
| Rate for Payer: Multiplan Commercial |
$91.52
|
| Rate for Payer: NAPHCARE Commercial |
$26.94
|
| Rate for Payer: Preferred Network Access Commercial |
$105.25
|
| Rate for Payer: Quartz Beloit One Network |
$56.06
|
| Rate for Payer: Quartz Commercial |
$74.36
|
| Rate for Payer: Quartz Medicare Advantage |
$17.96
|
| Rate for Payer: The Alliance Commercial |
$71.84
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.96
|
| Rate for Payer: United Healthcare PPO |
$85.80
|
| Rate for Payer: WEA Trust Commercial |
$62.92
|
| Rate for Payer: Wellcare Medicare |
$17.96
|
| Rate for Payer: WPS Commercial |
$84.73
|
|
|
Celiac Serology TTG
|
Facility
|
IP
|
$110.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
2790816
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$56.06 |
| Max. Negotiated Rate |
$105.25 |
| Rate for Payer: Aetna Commercial |
$102.96
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$98.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$60.63
|
| Rate for Payer: Cash Price |
$33.00
|
| Rate for Payer: Cigna Commercial |
$105.25
|
| Rate for Payer: Health EOS Commercial |
$101.82
|
| Rate for Payer: HFN Commercial |
$105.25
|
| Rate for Payer: Multiplan Commercial |
$91.52
|
| Rate for Payer: Preferred Network Access Commercial |
$105.25
|
| Rate for Payer: Quartz Beloit One Network |
$56.06
|
| Rate for Payer: Quartz Commercial |
$68.64
|
| Rate for Payer: WEA Trust Commercial |
$62.92
|
| Rate for Payer: WPS Commercial |
$84.73
|
|
|
Cell Count & Differential, BAL
|
Facility
|
IP
|
$109.00
|
|
|
Service Code
|
CPT 89051
|
| Hospital Charge Code |
5296695
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$55.55 |
| Max. Negotiated Rate |
$104.29 |
| Rate for Payer: Aetna Commercial |
$102.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$97.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$60.08
|
| Rate for Payer: Cash Price |
$32.70
|
| Rate for Payer: Cigna Commercial |
$104.29
|
| Rate for Payer: Health EOS Commercial |
$100.89
|
| Rate for Payer: HFN Commercial |
$104.29
|
| Rate for Payer: Multiplan Commercial |
$90.69
|
| Rate for Payer: Preferred Network Access Commercial |
$104.29
|
| Rate for Payer: Quartz Beloit One Network |
$55.55
|
| Rate for Payer: Quartz Commercial |
$68.02
|
| Rate for Payer: WEA Trust Commercial |
$62.35
|
| Rate for Payer: WPS Commercial |
$83.96
|
|
|
Cell Count & Differential, BAL
|
Facility
|
OP
|
$109.00
|
|
|
Service Code
|
CPT 89051
|
| Hospital Charge Code |
5296695
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.82 |
| Max. Negotiated Rate |
$104.29 |
| Rate for Payer: Aetna Commercial |
$102.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$97.49
|
| Rate for Payer: Aetna Managed Medicare |
$5.82
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$21.84
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$10.19
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$9.67
|
| Rate for Payer: Anthem Medicare Advantage |
$5.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$60.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5.82
|
| Rate for Payer: Cash Price |
$32.70
|
| Rate for Payer: Cash Price |
$32.70
|
| Rate for Payer: Cigna Commercial |
$104.29
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$5.82
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$63.44
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$5.82
|
| Rate for Payer: Health EOS Commercial |
$100.89
|
| Rate for Payer: HFN Commercial |
$104.29
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$21.67
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$5.82
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5.82
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$5.82
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$5.82
|
| Rate for Payer: Multiplan Commercial |
$90.69
|
| Rate for Payer: NAPHCARE Commercial |
$8.74
|
| Rate for Payer: Preferred Network Access Commercial |
$104.29
|
| Rate for Payer: Quartz Beloit One Network |
$55.55
|
| Rate for Payer: Quartz Commercial |
$73.68
|
| Rate for Payer: Quartz Medicare Advantage |
$5.82
|
| Rate for Payer: The Alliance Commercial |
$23.30
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.82
|
| Rate for Payer: United Healthcare PPO |
$85.02
|
| Rate for Payer: WEA Trust Commercial |
$62.35
|
| Rate for Payer: Wellcare Medicare |
$5.82
|
| Rate for Payer: WPS Commercial |
$83.96
|
|
|
Cell Count & Differential, BAL
|
Professional
|
Both
|
$109.00
|
|
|
Service Code
|
CPT 89051
|
| Hospital Charge Code |
5296695
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.82 |
| Max. Negotiated Rate |
$107.69 |
| Rate for Payer: Aetna Commercial |
$107.69
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$97.49
|
| Rate for Payer: Aetna Managed Medicare |
$5.82
|
| Rate for Payer: Anthem Medicare Advantage |
$5.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5.82
|
| Rate for Payer: Cash Price |
$32.70
|
| Rate for Payer: Cash Price |
$32.70
|
| Rate for Payer: Cigna Commercial |
$107.69
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$56.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5.82
|
| Rate for Payer: Health EOS Commercial |
$103.16
|
| Rate for Payer: HFN Commercial |
$107.69
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$20.56
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$20.56
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5.82
|
| Rate for Payer: Multiplan Commercial |
$90.69
|
| Rate for Payer: NAPHCARE Commercial |
$8.74
|
| Rate for Payer: Preferred Network Access Commercial |
$107.69
|
| Rate for Payer: Quartz Beloit One Network |
$49.88
|
| Rate for Payer: Quartz Commercial |
$64.62
|
| Rate for Payer: Quartz Medicare Advantage |
$5.82
|
| Rate for Payer: The Alliance Commercial |
$23.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.82
|
| Rate for Payer: WEA Trust Commercial |
$62.35
|
| Rate for Payer: WPS Commercial |
$25.63
|
|
|
Cell Count w/ Diff Body Fluid
|
Facility
|
IP
|
$189.00
|
|
|
Service Code
|
CPT 89051
|
| Hospital Charge Code |
633699
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$96.31 |
| Max. Negotiated Rate |
$180.84 |
| Rate for Payer: Aetna Commercial |
$176.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$169.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$104.18
|
| Rate for Payer: Cash Price |
$56.70
|
| Rate for Payer: Cigna Commercial |
$180.84
|
| Rate for Payer: Health EOS Commercial |
$174.94
|
| Rate for Payer: HFN Commercial |
$180.84
|
| Rate for Payer: Multiplan Commercial |
$157.25
|
| Rate for Payer: Preferred Network Access Commercial |
$180.84
|
| Rate for Payer: Quartz Beloit One Network |
$96.31
|
| Rate for Payer: Quartz Commercial |
$117.94
|
| Rate for Payer: WEA Trust Commercial |
$108.11
|
| Rate for Payer: WPS Commercial |
$145.59
|
|
|
Cell Count w/ Diff Body Fluid
|
Professional
|
Both
|
$189.00
|
|
|
Service Code
|
CPT 89051
|
| Hospital Charge Code |
633699
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.82 |
| Max. Negotiated Rate |
$186.73 |
| Rate for Payer: Aetna Commercial |
$186.73
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$169.04
|
| Rate for Payer: Aetna Managed Medicare |
$5.82
|
| Rate for Payer: Anthem Medicare Advantage |
$5.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5.82
|
| Rate for Payer: Cash Price |
$56.70
|
| Rate for Payer: Cash Price |
$56.70
|
| Rate for Payer: Cigna Commercial |
$186.73
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$98.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5.82
|
| Rate for Payer: Health EOS Commercial |
$178.87
|
| Rate for Payer: HFN Commercial |
$186.73
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$20.56
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$20.56
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5.82
|
| Rate for Payer: Multiplan Commercial |
$157.25
|
| Rate for Payer: NAPHCARE Commercial |
$8.74
|
| Rate for Payer: Preferred Network Access Commercial |
$186.73
|
| Rate for Payer: Quartz Beloit One Network |
$86.49
|
| Rate for Payer: Quartz Commercial |
$112.04
|
| Rate for Payer: Quartz Medicare Advantage |
$5.82
|
| Rate for Payer: The Alliance Commercial |
$23.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.82
|
| Rate for Payer: WEA Trust Commercial |
$108.11
|
| Rate for Payer: WPS Commercial |
$25.63
|
|
|
Cell Count w/ Diff Body Fluid
|
Facility
|
OP
|
$189.00
|
|
|
Service Code
|
CPT 89051
|
| Hospital Charge Code |
633699
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.82 |
| Max. Negotiated Rate |
$180.84 |
| Rate for Payer: Aetna Commercial |
$176.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$169.04
|
| Rate for Payer: Aetna Managed Medicare |
$5.82
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$21.84
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$10.19
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$9.67
|
| Rate for Payer: Anthem Medicare Advantage |
$5.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$104.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5.82
|
| Rate for Payer: Cash Price |
$56.70
|
| Rate for Payer: Cash Price |
$56.70
|
| Rate for Payer: Cigna Commercial |
$180.84
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$5.82
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$110.00
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$5.82
|
| Rate for Payer: Health EOS Commercial |
$174.94
|
| Rate for Payer: HFN Commercial |
$180.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$21.67
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$5.82
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5.82
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$5.82
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$5.82
|
| Rate for Payer: Multiplan Commercial |
$157.25
|
| Rate for Payer: NAPHCARE Commercial |
$8.74
|
| Rate for Payer: Preferred Network Access Commercial |
$180.84
|
| Rate for Payer: Quartz Beloit One Network |
$96.31
|
| Rate for Payer: Quartz Commercial |
$127.76
|
| Rate for Payer: Quartz Medicare Advantage |
$5.82
|
| Rate for Payer: The Alliance Commercial |
$23.30
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.82
|
| Rate for Payer: United Healthcare PPO |
$147.42
|
| Rate for Payer: WEA Trust Commercial |
$108.11
|
| Rate for Payer: Wellcare Medicare |
$5.82
|
| Rate for Payer: WPS Commercial |
$145.59
|
|
|
CELLULITIS AND OTHER BACTERIAL SKIN INFECTIONS
|
Facility
|
OP
|
$43.01
|
|
|
Service Code
|
EAPG 00673
|
| Min. Negotiated Rate |
$41.35 |
| Max. Negotiated Rate |
$43.01 |
| Rate for Payer: Anthem Medicaid |
$41.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$41.35
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$41.35
|
| Rate for Payer: Dean Health Medicaid |
$41.35
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$41.35
|
| Rate for Payer: Managed Health Services Medicaid |
$43.01
|
| Rate for Payer: Molina Healthcare Medicaid |
$41.35
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$41.35
|
| Rate for Payer: United Healthcare Medicaid |
$41.35
|
|
|
CELLULITIS AND OTHER SKIN INFECTIONS
|
Facility
|
IP
|
$4,208.79
|
|
|
Service Code
|
APR-DRG 3831
|
| Min. Negotiated Rate |
$3,738.51 |
| Max. Negotiated Rate |
$4,208.79 |
| Rate for Payer: Anthem Medicaid |
$4,030.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$4,030.15
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$4,030.15
|
| Rate for Payer: Dean Health Medicaid |
$4,030.15
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$3,738.51
|
| Rate for Payer: Managed Health Services Medicaid |
$4,208.79
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,030.15
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$4,030.15
|
| Rate for Payer: United Healthcare Medicaid |
$4,030.15
|
|
|
CELLULITIS AND OTHER SKIN INFECTIONS
|
Facility
|
IP
|
$5,611.72
|
|
|
Service Code
|
APR-DRG 3832
|
| Min. Negotiated Rate |
$4,984.68 |
| Max. Negotiated Rate |
$5,611.72 |
| Rate for Payer: Anthem Medicaid |
$5,373.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$5,373.53
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$5,373.53
|
| Rate for Payer: Dean Health Medicaid |
$5,373.53
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$4,984.68
|
| Rate for Payer: Managed Health Services Medicaid |
$5,611.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,373.53
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$5,373.53
|
| Rate for Payer: United Healthcare Medicaid |
$5,373.53
|
|
|
CELLULITIS AND OTHER SKIN INFECTIONS
|
Facility
|
IP
|
$16,747.47
|
|
|
Service Code
|
APR-DRG 3834
|
| Min. Negotiated Rate |
$14,876.15 |
| Max. Negotiated Rate |
$16,747.47 |
| Rate for Payer: Anthem Medicaid |
$16,036.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$16,036.63
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$16,036.63
|
| Rate for Payer: Dean Health Medicaid |
$16,036.63
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$14,876.15
|
| Rate for Payer: Managed Health Services Medicaid |
$16,747.47
|
| Rate for Payer: Molina Healthcare Medicaid |
$16,036.63
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$16,036.63
|
| Rate for Payer: United Healthcare Medicaid |
$16,036.63
|
|
|
CELLULITIS AND OTHER SKIN INFECTIONS
|
Facility
|
IP
|
$8,768.31
|
|
|
Service Code
|
APR-DRG 3833
|
| Min. Negotiated Rate |
$7,788.56 |
| Max. Negotiated Rate |
$8,768.31 |
| Rate for Payer: Anthem Medicaid |
$8,396.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$8,396.14
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$8,396.14
|
| Rate for Payer: Dean Health Medicaid |
$8,396.14
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$7,788.56
|
| Rate for Payer: Managed Health Services Medicaid |
$8,768.31
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,396.14
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$8,396.14
|
| Rate for Payer: United Healthcare Medicaid |
$8,396.14
|
|
|
CELLULITIS WITH MCC
|
Facility
|
IP
|
$41,461.68
|
|
|
Service Code
|
MSDRG 602
|
| Min. Negotiated Rate |
$11,391.38 |
| Max. Negotiated Rate |
$41,461.68 |
| Rate for Payer: Aetna Managed Medicare |
$11,391.38
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$31,011.63
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$23,770.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$22,583.21
|
| Rate for Payer: Anthem Medicare Advantage |
$11,391.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$11,391.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$11,391.38
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$11,391.38
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$25,069.43
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$11,391.38
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$30,166.50
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$11,391.38
|
| Rate for Payer: Independent Care Health Plan Medicare |
$11,391.38
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$11,391.38
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$11,391.38
|
| Rate for Payer: NAPHCARE Commercial |
$17,087.07
|
| Rate for Payer: Quartz Medicare Advantage |
$11,391.38
|
| Rate for Payer: The Alliance Commercial |
$41,461.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$11,391.38
|
| Rate for Payer: United Healthcare PPO |
$23,485.01
|
| Rate for Payer: Wellcare Medicare |
$11,391.38
|
|
|
CELLULITIS WITHOUT MCC
|
Facility
|
IP
|
$24,794.64
|
|
|
Service Code
|
MSDRG 603
|
| Min. Negotiated Rate |
$7,176.30 |
| Max. Negotiated Rate |
$24,794.64 |
| Rate for Payer: Aetna Managed Medicare |
$7,176.30
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$19,002.34
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$14,565.14
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$13,837.83
|
| Rate for Payer: Anthem Medicare Advantage |
$7,176.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$7,176.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$7,176.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$7,176.30
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$15,361.27
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$7,176.30
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$17,941.72
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$7,176.30
|
| Rate for Payer: Independent Care Health Plan Medicare |
$7,176.30
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$7,176.30
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$7,176.30
|
| Rate for Payer: NAPHCARE Commercial |
$10,764.45
|
| Rate for Payer: Quartz Medicare Advantage |
$7,176.30
|
| Rate for Payer: The Alliance Commercial |
$24,794.64
|
| Rate for Payer: United Healthcare Medicare Advantage |
$7,176.30
|
| Rate for Payer: United Healthcare PPO |
$13,967.86
|
| Rate for Payer: Wellcare Medicare |
$7,176.30
|
|
|
CEMENT BONESYNC CALCIUM PHOSPHATE DRILLABLE FAST SET 3CC ABS-3103
|
Facility
|
OP
|
$6,649.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5603744
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,936.19 |
| Max. Negotiated Rate |
$6,361.76 |
| Rate for Payer: Aetna Commercial |
$6,223.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,946.87
|
| Rate for Payer: Aetna Managed Medicare |
$1,936.19
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,494.72
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,457.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,319.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,664.93
|
| Rate for Payer: Cash Price |
$1,994.70
|
| Rate for Payer: Cigna Commercial |
$6,361.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,869.72
|
| Rate for Payer: Health EOS Commercial |
$6,154.31
|
| Rate for Payer: HFN Commercial |
$6,361.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,186.22
|
| Rate for Payer: Multiplan Commercial |
$5,531.97
|
| Rate for Payer: NAPHCARE Commercial |
$4,148.98
|
| Rate for Payer: Preferred Network Access Commercial |
$6,361.76
|
| Rate for Payer: Quartz Beloit One Network |
$3,388.33
|
| Rate for Payer: Quartz Commercial |
$4,494.72
|
| Rate for Payer: Quartz Medicare Advantage |
$4,148.98
|
| Rate for Payer: The Alliance Commercial |
$3,457.48
|
| Rate for Payer: WEA Trust Commercial |
$3,803.23
|
| Rate for Payer: WPS Commercial |
$5,121.72
|
|
|
CEMENT BONESYNC CALCIUM PHOSPHATE DRILLABLE FAST SET 3CC ABS-3103
|
Facility
|
IP
|
$6,649.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5603744
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,388.33 |
| Max. Negotiated Rate |
$6,361.76 |
| Rate for Payer: Aetna Commercial |
$6,223.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,946.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,664.93
|
| Rate for Payer: Cash Price |
$1,994.70
|
| Rate for Payer: Cigna Commercial |
$6,361.76
|
| Rate for Payer: Health EOS Commercial |
$6,154.31
|
| Rate for Payer: HFN Commercial |
$6,361.76
|
| Rate for Payer: Multiplan Commercial |
$5,531.97
|
| Rate for Payer: Preferred Network Access Commercial |
$6,361.76
|
| Rate for Payer: Quartz Beloit One Network |
$3,388.33
|
| Rate for Payer: Quartz Commercial |
$4,148.98
|
| Rate for Payer: WEA Trust Commercial |
$3,803.23
|
| Rate for Payer: WPS Commercial |
$5,121.72
|
|
